While everyone has experienced sadness, not everyone has experienced depression. If you’ve never been depressed, chances are you don’t have a real grasp of what living with this complex mental illness is like.

Depression is insidious. It affects not only your mood, but also your ability to feel, think, and function. It blunts sensations of pleasure, closes off connectedness, stifles creativity, and, at its worst, shuts down hope. It also often causes deep emotional pain not only to the person experiencing it, but to that person’s close family and friends.

“It’s not what people think, an act of laziness or a lack of will for change,” says E. Mollie Kashuk, a 21-year-old college senior in Claremont, California. “Instead, it’s genuinely believing that change is not possible for you. It’s genuinely believing that you’re stuck in an overwhelming darkness that will never go away.”

Common Questions & Answers

How do I know if I’m depressed?

Typical signs of depression in adults include persistent feelings of sadness or emptiness, irritability, overwhelming guilt, anxiety, frustration, or anger, changes in appetite, an inability to concentrate, and loss of interest in previously enjoyed activities, among other symptoms.
What causes depression?

Can depression go away on its own?

How long does it take antidepressants to work?

Is alcohol a depressant?

Depression Statistics: Disturbing Trends, Helpful Treatment

Unfortunately, there are plenty of people who, like Kashuk, know exactly what it means to be depressed. In 2020, an estimated 21 million, or 8.4 percent, of adults in the United States had at least one major depressive episode in the past year, according to the National Institute of Mental Health, making it one of the most common mental illnesses in the United States.

What’s more, a recent report from Mental Health America, a nonprofit founded in 1909, offers startling statistics pertaining to one of depression’s most disturbing symptoms: thoughts of suicide.

According to its 2022 State of Mental Health in America report, suicidal ideation among adults increased to 4.58 percent (an additional 664,000 people) in 2022.
There is a bright side. Although there is no one-size-fits-all cure for depression, there are many effective treatment options, one of which is bound to help you heal if you’re struggling with the illness. This cannot be emphasized enough, given that roughly two-thirds of people living with depression do not receive the care they need, according to a report in the journal Neuropsychiatric Disease and Treatment, published online February 22, 2019.

Learn More About Suicide Risk and Prevention

Signs and Symptoms: How to Identify Depression
If sadness alone isn’t a good gauge of depression, what is? According to the American Psychiatric Association’s (APA) current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the diagnostic guide used by most mental health professionals, if you’ve experienced at least five of the following symptoms most of the day, nearly every day, for at least two weeks, you may be diagnosed with major depressive disorder (MDD), also known as clinical depression.

Do you:

  • Constantly feel tearful, empty, or worthless?
  • Have little interest or pleasure in your work, hobbies, friends, family, and other things you once enjoyed?
  • Notice dramatic changes up or down in your appetite or your weight not related to dieting?
  • Often feel listless or fatigued for no obvious reason?
  • Have trouble concentrating or making decisions?
  • Find yourself wringing your hands, pacing, or showing other signs of anxious restlessness — or the opposite, moving or speaking more slowly than usual?
  • Struggle with insomnia or sleep too much?
  • Have recurrent thoughts of suicide or death?

To be diagnosed with MDD, one of your symptoms must be a persistent low mood or a loss of interest or pleasure, the DSM-5 states. Your symptoms must also not be due to substance abuse or a medical condition, such as thyroid problems, a brain tumor, or a nutritional deficiency.

Of course, it’s normal to have any or all of these symptoms temporarily (for hours or even days) from time to time. The difference with depression is that the symptoms persist and make it difficult to function normally.

If you suspect you may be depressed, the best first step is to reach out to your primary care doctor, a psychiatrist, or a psychotherapist. If you’re reluctant to consult a professional, type “depression” or “clinical depression” into Google on your cellphone or computer and you’ll find links to a clinically validated depression test known as the PHQ-9 patient health questionnaire (PDF). Although designed to be administered by a healthcare professional, this test is short and straightforward. Take it and you can immediately see if your score indicates you may have depression.

Important: If you suspect you have depression, or if you’re feeling troubled by your symptoms, have suicidal thoughts, just need to talk, want some advice, or need a referral for treatment, call the Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) at the three-digit code 988, or the National Substance Abuse and Mental Health Services Administration Helpline at 800-662-HELP (4357). Both are free and available 24/7, 365 days a year.

Learn More About Depression Symptoms

What Are the Different Types of Depression?

In addition to MDD there are several other kinds of depression, including:

  • Persistent depressive disorder (PDD) Previously known as dysthymia, PDD is diagnosed in people who have at least two of the symptoms of major depression for at least two years at a time. It’s possible to fluctuate between severe and less-severe symptoms, and to have both PDD and MDD at the same time, a condition called double depression. People with PDD are often perceived as cranky, sullen, changeable, or pessimistic rather than being recognized as having a treatable disorder.
  • Bipolar disorder, formerly called manic depressive disease, is characterized by moods that cycle between extreme highs (mania) and lows (depression), often with periods of normal mood in between. Bipolar disorder affects 2.8 percent of U.S. adults.
  • Seasonal affective disorder (SAD) is depression that occurs at the same time each year, usually beginning in fall and persisting through winter. SAD is associated with changes in sunlight, and is often accompanied by increased sleep, weight gain, and cravings for foods high in carbohydrates.
  • Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMDD usually develops a week or two before a woman’s period and passes two or three days after menstruation starts.
  • Postpartum (or perinatal) depression (PPD) is diagnosed in mothers who experience symptoms of major depression shortly after giving birth.

     PPD is usually related to a combination of factors, including sharp changes in hormone levels following childbirth. Feelings of intense sadness, anxiety, or exhaustion are much stronger, and last longer, than the “baby blues” — the relatively mild symptoms of depression and anxiety that many new mothers experience in the first few days after childbirth.

Depression: Recognizing Unusual Symptoms

One reason depression can be hard to identify is that its signs can vary widely from person to person and sometimes be masked by atypical symptoms. For example, some people who are depressed may show it by acting disgruntled, resentful, or irritable. In fact, aggression — including outright acts of violence — can be indicative of “hidden” depression, according to a February 27, 2017, report in Psychiatric Times.
Depression masquerading as anger may seem surprising at first, but not when you consider that several underlying factors, including alcohol or substance abuse and childhood trauma, have been linked to both.
Similarly, although it’s not clear why, a person who experiences anxiety is at high risk for developing depression, and vice versa. The National Alliance on Mental Illness reports that as many as 60 percent of people with anxiety will also have symptoms of depression; the same goes for people with depression having symptoms of anxiety.

 Experts say there is often a genetic predisposition for these co-occurring disorders.

Depression may also manifest psychosomatically, meaning that instead of presenting first and foremost as a mood disorder, the dominant symptom may be things like vague aches, dizziness, headaches, digestive problems, or back pain, according to a review published in the Journal of Clinical Psychiatry.right up arrow

 Complicating matters is that it’s often hard to know whether depression is causing the physical symptoms, or if the physical symptoms are causing depression.
What Causes Depression?
No one knows for sure why some people become depressed and others do not. Depression can occur spontaneously, without any obvious cause. And it’s well documented that once you’ve had one depressive episode, your risk of having another later in life increases. For example, a study in Psychological Medicine found that more than 13 percent of people who recover from their first episode of major depression go on to have another episode within five years; 23 percent within 10 years; and 42 percent within 20 years.
Psychiatrists today generally look at depression in “bio-psycho-social” terms, meaning that they see it as a complex disorder most likely triggered by overlapping biological, psychological, and social (also referred to as environmental) factors.

Among the potential contributors to depression are:

  • Genetics Many studies suggest that depression can spring from a genetic predisposition, including one international study involving more than 807,000 people, published in the February 2019 issue of the journal Nature Neuroscience, that linked 269 genes to depression. Genes alone are not believed to write your destiny, however. Scientists think that while some genes may increase risk, other factors are needed to trigger symptoms.
  • Neurotransmitters The long-held idea that depression is caused by low levels of certain neurotransmitters (chemical messengers that communicate between neurons) has been debunked. But it’s clear that neurotransmitters play a role, at least for some people. Experts’ current belief is that the relationship between depression and neurotransmitters is complex and may be related to nerve cell connections, nerve cell growth, or the functioning of nerve circuits.
  • Inflammation Multiple studies indicate that disease-related or stress-related inflammation may create chemical changes in the brain that can trigger or worsen depression in certain people and influence how a person responds to drug therapy.
  • Hardship There’s growing evidence, according to the World Health Organization, that psychological and social factors like a history of abuse, poor health and nutrition, unemployment, social isolation or loneliness, low socioeconomic status, or stressful life events (divorce or money worries, for example) can play a decisive role in the onset of depression. For example, adults with MDD have double the rate of childhood trauma compared with people without MDD, a study published May 3, 2016, in the journal Translational Psychiatry showed.
  • Traumatic brain injury (TBI) Another all-too-common cause of depression is TBI. In 2019, more than 223,000 people were hospitalized for TBIs (aka concussions) following a bump or blow to the head from things like falls, assaults, car accidents, and workplace and sports-related injuries, according to the Centers for Disease Control and Prevention. And more than half of those patients will meet the criteria for major depression three months after their injury, suggests a study published November 30, 2017, in the journal Brain Injury.

Depression and Gender: Is It Different in Men and Women?

When it comes to depression, there is a distinct gender gap. Depression is nearly twice as common in women as in men, according to data from the National Center for Health Statistics.
Hormonal and other biological factors play a role in this disparity. After all, only cisgender women and people with a uterus can have premenstrual or postpartum depression. The same is true of antepartum (or perinatal) depression — depression during pregnancy — which the American College of Obstetricians and Gynecologists estimates affects one in seven women.

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